Provider Demographics
NPI:1114091865
Name:NOBOA, JACQUELINE FRANCIA (DPM)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:FRANCIA
Last Name:NOBOA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3898 SEDGWICK AVENUE
Mailing Address - Street 2:2L
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-548-1988
Mailing Address - Fax:718-548-1988
Practice Address - Street 1:3898 SEDGWICK AVENUE
Practice Address - Street 2:2L
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:718-548-1988
Practice Address - Fax:718-548-1988
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004510213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY480015944OtherPALMETTO GBA RAILROAD MED
NY0021631OtherGHI
NY01132636Medicaid
NY000592413OtherAPWU
T82991Medicare UPIN
NY01132636Medicaid